Healthcare Provider Details

I. General information

NPI: 1285497032
Provider Name (Legal Business Name): RESOLUT MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 5TH AVE
NEW YORK NY
10003-3019
US

IV. Provider business mailing address

85 5TH AVE
NEW YORK NY
10003-3019
US

V. Phone/Fax

Practice location:
  • Phone: 212-993-7809
  • Fax:
Mailing address:
  • Phone: 212-993-7809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TAKASHI NAKAMURA
Title or Position: PRESIDENT
Credential: MD
Phone: 808-258-2370